If you have unstable angina...

If you have unstable angina, wouldn't you also have to have pain with exertion, too. I mean, if a blocked artery is causing your pain at rest, wouldn't it have to cause it during exertion, too? I'm really confused. I know that unstable angina occurs at rest, but I can't understand why it wouldn't cause pain during exertion, too.
Can someone enlighten me?

Here is why I ask. I have been having severe chest pains at rest, but I do not get them when I'm walking on the treadmill, or exerting myself in anyway.

Thank so much!

The following user gives a hug of support to SeaBreezes:
donny lad (03-13-2011)

Yes it confuses me too and I am a veteran of these wars. I would think that someone with unstable angina would ALSO have an exercise intolerance.
I think that UNSTABLE includes STABLE but not vice versa.

There may however be an arterial spasmodic effect that contributes to the easy blockage of blood that could be pronounced in the unstable sufferers, like during sleep, that may not be a bother to stable angina "people." (LOL, I neve know whether to use the word patient, sufferer, people, things...the Romans had the perfect word RES!

Sometimes people with chest pain at rest have spasms in the artery that cause a tempery blockage and pain. One of the ways to diagnose the condition, but not the only way, is that the angina is mostly at rest rather than exercise. One person I know of had a spasm during a heart cath but that is rare.

I understand that angina that is caused from an artery spasm is called variant angina. Oh I just had to throw in something else to make it harder to figure it all out. Lady... did they use the drug egovorine on the person during his heart cath? They use this to see if you do have arterial spasms. They also call this Prinzmetal angina. I would like to more on this if anyone knows. Thanks

Oh great....the anginas are endless by the sound of it...I am also curious about the unstable being only at rest....and what is happening at this time. My husband was diagnosed with variant angina(prinzmetal) and they said it is when the arteries are in a spasm so what are they doing during unstable angina???

Not sure if this will explain it a bit better, or not--you can let me know. When I first developed angina, I felt it only when I exerted myself. Always took some level of exertion, and even though I was clueless to understand that the pain was heart-related, it was stable. As time progressed, it would occur while I was typing at the computer. It would come on and go away, with no apparent rhyme or reason--> That is unstable.

After my first stent, the unstable angina disappeared. I still had one artery with 50% plus blockage. I did not feel any pain at rest, but every time I started to run, the same pain (angina) would occur 15 seconds into the run. Experimenting with myself, I would try to run 6 times in a row, then ease up and walk and the pain would come on, then subside slowly. This is stable (reproducible). When there is stable angina, then the use of nitro, or perhaps even easing up from exertion will solve the problem. If it were unstable (again), then it would be time for me to head to the hospital for intervention.

Seabreezes,

1. Not really, unless part of the problem is that the artery that spasms has plaque buildup in the area where the spasm(s) occur(s). The variant nature makes it very difficult to observe.

2. I don't have any information to give you a good answer to this question. Onset could be related to stressful situations.

3. I don't think an angiogram could diagnose this condition...but I am not a cardiologist either.

4. The symptoms could be any of a number or combination of symptoms felt by those that can experience angina, whether its chest pain, back pain , chest pressure, jaw and neck pain, arm and shoulder pain, etc. Angina, when felt, can be experienced in many different ways.

5. The pain is caused by heart muscle tissue under the burden of reduced oxygen delivery to it (ischemia). While the artery spasms, the tissue is not receiving enough oxygen. But do keep in mind that this tissue is pretty resilient and able to endure some periods of decreased oxygen delivery. Only when this period continues does a MI result.

Thanks Cobalt for the info.. So unstable angina happens at rest but not necessarily while sleeping. My husbands happened at sleep, it woke him up. Read Seabreezes post on Prinzmetal, variant angina if you have time. Thank you for the info on unstable. Lesley

With reference to Seabreezes variant angina post--it can come on at any time, regardless of exercise/exertion, rest etc. It's not technically the same though as unstable angina from the plaque buildup. With the buildup, there is always a chance of rupture and clotting, or in the least, the natural progression of disease results in reduced bloodflow for a great enough time that a MI will eventually occur.

As for angina at rest vs. exercise, I remember explaining to the ER docs on my 4th visit to the ER (2nd false alarm) that I thought I felt angina at rest, but was fine when I was exercising (running). They all gave me funny looks. As it turned out, they were right that time. But again, I don't have variant angina. All of my problems are/were clearly visible on the screen during the angiograms.

Can unstable angina occur at sleep? Absolutely. If there is a rupture and clot formation, without a doubt. Even with heavily occlusion from plaque, although the demand for oxygen is normally reduced at sleep, so angina will usually lessen unless there has been a rupture. The night before my MI, I went to bed because the pain was so intense, I slept overnight and that alleviated the pain. Within 30 seconds of waking up the next morning, the same pain returned. Unstable angina occurs at rest, and that was what was happening to me that morning. If I had tried to do some heavy exercise at that time, I would have probably achieved the MI earlier that morning rather than just after I ate my lunch.

The Following User Says Thank You to CobaltBlue For This Useful Post:
msdizzydolores (09-08-2012)

Hmmm Sorry you have been through so much too. As you have probably read in other posts my husband had an MI due to prinzmetal. His artery spasmed occluded and stayed occluded so long that it caused some muscle damage. Now I am confused though....we were told at the Heart Institute that it (PM) happens during sleep?? And between the hours of midnight and 8 am this is how they determined it was caused from variant angina. Although he did have an angio and his arteries were perfect. I specifically asked can this happen morning ,noon or night, and they told me it happens in early morning hours?? What do you think??L

I had coronary artery spasms or unstable angina or prinzmetal angina(never really got a name for it). Spasms were most severe in the night or early morning hours. I would be awakened during sleep but they could also happen at any hour of the day. I didn't have them until I got a stent and then even had them after my stent failed and I needed bypass surgery to one artery. They have stopped now except under extremely stressful situations such as a recent death of my 20 year old nephew. It's the first time I've needed nitro in over a year. It has been explained to me that there are just certain times of the day that the arteries narrow down a bit and may also spasm. Cardiac syndrome X hasn't been mentioned yet and with that there is no disease present on an angiogram but the patient experiences angina. I'm trying to answer some questions but may be actually confusing you even more. My spasms were not diagnosed during my angiogram because from what I understand if there is blockage it would be too dangerous to inject a chemical that could cause a spasm. I know that they were spasms in part because they were so rhythmic. It was like a squeezing and then letting go and then repeating.

I think people can have both, Variant/Prinzmetal and CAD. I know I do but they could not test me for this during the Cath as they did see some blockages. The blockages were stented and those dang severe, out of the blue, Angina pains continued and all I got was "you just can't be having those pains, you've been stented"...Well, I still have them and I will bet my bank account that I do have Prinzmetal/Variant Angina which is coming from tiny arteries that they just cannot see with the human eyeball.

In fact, I just read an article on this and they state that more than 75% that have Prinzmetal/Variant Angian will have an obstruction somewhere.

Hmmm Sorry you have been through so much too. Although he did have an angio and his arteries were perfect. I specifically asked can this happen morning ,noon or night, and they told me it happens in early morning hours?? What do you think??L

Thanks Susie, but to be honest, I wouldn't trade what happened for anything now. I deserved it! I was lazy, obese, diabetic, eating a terrible diet. Were it not for those experiences, I wouldn't have been shocked back into reality and doing the things to take care of myself.

I don't know much about variant angina at all (no physical experience to draw upon), nor it's symptoms. I have run across it when reading the literature but I don't pay as great attention to it since I am trying to read mostly about my own situation.... I do think it can happen anytime, but that is just my guess.

Plus as Macy Maid and Ninelives pointed out, there are people that have both, and I have a feeling that variant angina in them is even more dangerous because during a spasm at an occluded location, there is even less space to interrupt the flow of oxygen, temporarily.

------

Lenin, as you probably remember from your own angiogram, those weren't bad--neat to watch . The only bad one was the first, when I had to be defibrillated--now that was murder